European clinical respiratory journal
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Severe asthma is a discrete clinical entity characterised by recurrent exacerbations, reduced quality of life and poor asthma control as ordinary treatment regimens remain inadequate. Difficulty in managing severe asthma derives partly from the multiple existing phenotypes and our inability to recognise them. Though the exact pathogenetic pathway of severe allergic asthma remains unclear, it is known that numerous inflammatory cells and cytokines are involved, and eosinophils represent a key inflammatory cell mediator. ⋯ Moreover, to date, markers indicative of the patient population responding to each treatment are unavailable although baseline eosinophils and exacerbation rate in the previous year demonstrate a predictive value regarding anti-IL-5 therapy effectiveness. On the other hand, a better therapeutic response for omalizumab has been observed when low forced expiratory volume in 1 sec, high-dose inhaled corticosteroids and increased IgE concentrations are present. Consequently, conclusions are not yet safe to be drawn based on existing knowledge, and additional research is necessary to unravel the remaining issues for the severe asthmatic population.
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Pulmonary hypertension (PH) is a serious complication to interstitial lung disease (ILD) and has a poor prognosis. PH is often diagnosed by screening with echocardiography followed by right heart catheterisation. A previous study has shown that a value of NT-pro-brain natriuretic peptide (NT-proBNP) <95 ng/l could be used to rule out PH in patients with ILD. ⋯ NT-proBNP <95 ng/l precludes a positive echocardiographic screen for PH in ILD patients at referral for diagnostic workup.
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Pre-hospital, high-concentration oxygen therapy during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been associated with increased mortality. Recent COPD guidelines have encouraged titrated oxygen therapy with a target saturation range of 88-92%. Oxygen therapy leading to saturation above 92% is defined as 'inappropriate oxygen therapy'. ⋯ The majority of patients with AECOPD received inappropriate oxygen therapy in the ambulance, but their need of ventilatory support, length of stay, and mortality were low. Randomised studies are needed to clarify the optimal pre-hospital oxygen therapy.